Sociological Approaches to Chronic Illness Flashcards
What does the term chronic illness emcompass?
A wide range of conditions
What are the features of chronic illnesses?
- Long term
- Has a profound influence on the life of suffererse
- Often have co-morbid conditions
- Manifestations vary greatly day-to-day
- Can be controlled, but not cured
What is the problem with manifestations of chronic illnesses varying greatly day-to-day?
Leads to a lot of uncertainty, and issues managing life and social interactions
Why is the incidence of chornic illnesses increasing?
Due to the aging population
What % of GP appointments to people with long term conditions account for?
50%
What % of all outpatient appointments do people with long term conditions account for?
64%
What % of all inpatient bed days to people with long term conditions account for?
70%
What % of the total health care spend in England do people with long term conditions account for?
Around 70%
What is a detailed understanding of the impact of chronic illness and disability on daily life necessary for?
For providers of medical and social services to offer appropriate care and support
Why is a sociological approach to chronic illness distinct?
- Focuses on how chronic illness impacts on social interaction and role performance
- Modern theory is mostly derived from studies in the interactionalist tradition
- Concerned with experiences and meanings of chronic illness
- Interested in how people manage and negotiate chronic illness in everyday life
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- Interested in how people manage and negotiate chronic illness in everyday life
What do illness narratives refer to?
Story telling and accounting practices that occur in the face of illness
What happens in an illness narrative?
A patient can ‘tell the story’ of their illness
What is the advantage of narrative interviews?
Can see what the patient places significance on, and what is important to them
What is much of the sociological research on chronic illness based on?
Peoples narratives of their illness
What do illness narratives offer?
Information about how the patient makes sense of something, and thus an insight into lay beliefs, and how they perform certain functions
What types of work does the sociological theory of chronic illness say there is?
- Illness work
- Everyday life work
- Emotional work
- Identity work
- Biographical work
What does illness work constitute?
- Work getting a diagnosis
- Managing the symptoms
- Self-management
What aspects of getting a diagnosis can be problematic?
- May be prolonged period of uncertainty
- Problems arise from ambivalent status of some diagnoses
- Process can be very unpleasant
- Diagnosis itself
When may there be a prolonged period of uncertainty when getting a diagnosis?
If conditions are complex or unusual, or not the normal candidate
When may the process of getting a diagnosis be very unpleasant?
Patient may have to be very proactive
What may a diagnosis be?
- Profoundly shocking
- Very threatening
- A relief
Why may a diagnosis be a relief?
Finally have a diagnostic label so can do something about it
What is central to the coping with chronic illness task?
Dealing with the physical manifestations of illness
What has management of symptoms need to be done before?
Coping with social relationships
How does the body in chronic illness interact with identity?
- Uncontrollable problematic behaviour can impact on who you can be, and what you can do
- Bodily changes can lea to self-perception changes
What is the problem with optimum-self management?
It is difficult to achieve
What can sub-optimum self management lead to?
- Poor rates of adherence to treatment
- Reduced quality of life
- Poor psychological wellbeing
How can self-management be improved?
Can provide brief interventions
How can interventions to improve self management be delivered?
- Online
- In person
- Via telephone
How to interventions to improve self management vary?
In effectiveness/quality
Give an example of an intervention aimed to improve self-management?
The ‘expert patient programme’
What does the ‘expert patient programme’ do?
Teaches coping and condition management skills, and aims to reduce hospital admissions
What is the expert patient programme facilitated by?
Patients
What are the disadvantages of the expert patient programme?
- Responsibility for care is placed on very ill patients, who sometimes have to do significant, complex work
- Little evidence of efficiency savings
What is doing in everyday life work?
- Coping and strategic management
- Normalisation
What is coping?
The cognitive processes involved in dealing with illness
What does strategy refer to?
The action and processes involved in managing the condition and its impact
Give two examples of strategy in chronic illness
- Decisions about mobilisation of resources
- Decisions about how to balance demands on others and remain independant
What are the methods of normalisation in chronic illness?
- Some try and keep pre-illness lifestyle and identity intact
- Some redesignate new life as ‘normal life’
How does a person keep pre-illness lifestyle and identity intact?
Disguise or minimise symptoms
How does a person redesignate their illness life as ‘normal life’?
May involve people signalling changes in identity, rather than preserving old ones
Over what time scale does redesignation of new life as ‘normal life’ take place?
Can occur over a very short period of time if a rapid onset illness
What does emotional work refer to?
The work that people do to protect the emotional well-being of others
What happens in emotional work?
Maintaining normal activities becomes deliberately conscious
Why don’t people let others see that they’re feeling unwell?
Don’t want to upset people around them
Who may the hiding of symptoms of a chronic illness extend to?
HCP
What is important considering that some people with chronic illness will hide their symptoms from HCPs?
HCPs must have the skills to break this down
What may happen regarding friendships in chronic illness?
May find friendships disrupted, and may strategically withdraw or restrict their social terrain
What may emotional work involve?
Downplaying pain or other symptoms, to present ‘cheery self’
What does the devastating impact on role in chronic illness refer to?
How people position themselves in a social sphere
How may role change in chronic illness?
Dependency, and feeling of uselessness to self and others
Who may the role change in chronic illness be especially devastating for?
Young people
Why is biographical work needed in chronic illness?
Because there is a loss of self as a former self-image crumbles away without simultaneous development of equally valued new ones
What is the constant struggle in chronic illness, regarding biographical work?
To lead valued lives and maintain positive definitions of self
What is it argued regarding the focus on physical discomfort in chronic illness?
It minimises the broader significance of suffering for people with chronic illness
Why is chronic illness a major disruptive experience?
- Threatens sense of taken-for-granted world
- New consciousness of the body, and fragility of life
- May experience grief for former life
- Biographical sift from a perceived normal trajectory to an abnormal one
Why is identity work needed in chronic illness?
Different conditions carry different connotations and certain cultural stereotypes, which affects how people see themselves and how others see them
What is the risk with chronic illness regarding identity?
Illness can become the defining aspect of identity
What is stigma?
A negatively defined condition, attribute, trait, or behaviour conferring ‘deviant’ status
What may result in stigma?
Control of the body means that we present ourselves in socially valued ways, and failure to do this may result in stigma
What types of stigma are there?
- Discreditable
- Discrediting
What is discreditable stigma?
When nothing is seen, but if it was found out, may be treated differently
Give two examples of conditions that may produce discreditable stigma?
- Mental illness
- HIV +ve
What is the difficulty with discredibable stigma?
Have to decide who to tell, how, when, and what are the implications?
What is discrediting stigma?
When there is a physically visible characteristic, or something that is well known
Give two examples of conditions giving discrediting stigma?
- Physical disability
- Known suicide attempt
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- Known suicide attempt
What are the ways of experiencing stigma?
Can be felt, or enacted
What is enacted stigma?
The real experience of prejudice, discrimination, and disadvantage as a consequence of a condition
What is felt stigma?
The fear of enacted stigma
What does felt stigma also encompass?
The feeling of shame associated with having a condition
What does felt stigma lead to?
Selective concealment
What has evidence shown that most chronic disorders are in their effects?
Disabling
Describe the relationship between chronic illness and disability?
Complex and disrupted issue
What does the medial model say about disability?
Disability is deviation from medical norms, and disadvantages are a direct consequence of impairment and disabilities which needs medical intervention to cure or help
What are the critiques of the medical model of chronic illness?
- Lack of recognition of social and psychological factors
- Stereotyping and stigmatising language
What are doctors trying to do, regarding the medical model?
Move away from thinking in a purely medical model
What does the social model say about chronic illness?
Problems are a product of the environment, and a failure of the environment to adjust
What is meant by disability being a product of the environment?
Disability is a function of a society which fails to take into account people with impairments, and special needs are only in a particular context
What is disability a form of, according to the social model?
Social oppression
What does the social model say is needed to combat chronic conditions?
Political action and social change
What are the critiques of the social model of chronic conditions?
- Body is left out
- Overly drawn view of society
- Failure to recgonise bodily realities and extent to which these are solvable socially
What did the International Classification of Impairments, Disabilities, or Handicaps (ICIDH) do?
Attempted to classify consequences of dieases
What concepts did the ICIDH offer?
- Impairment
- Disability
- Handicap
What is impairment concerned with?
Abnormalities in the structure or functioning of the body
What is disability concerned with?
The performance of activity
What is handicap concerned with?
Broader social and psychological consequences of living with impairment or disability
Is there a relationship between the severity of impairment and of resulting disability or handicap?
Not necessarily
What are the criticisms of the ICIDH?
- Problematic use of term ‘handicap’
- Implies problems are intrinsic or inevitable
- Embodied many features of medical model
What is the International Classification of Functions, Disability, and Health (ICFDH)?
WHO’s framework for measuring health and disability at borth individual and population levels
When was the ICFDH officially endorsed by all WHO member states?
In the 54th World Health Assembly in 22nd May 2001
What is the ICFDH endorsed for?
Use as the international standard to describe and measure health and disability
What does the ICFDH attempt to do?
Integrate medical and social models, and recognise the significance of wider environment
What are the key components of ICFDH?
- Body structures and functions, and impairments of/to
- Activities undertaken by the individual, and difficulties/limitations experienced in doing them
- Participation or involvement in life situations, which may become restriction
What are all the components, and relationships between them, affected by in the ICFDH?
Personal and environmental contextual factors
